How to Fix Brain Fog: Root causes, Lifestyle, and Nootropics

Medically Reviewed by Board Certified Dr. Neil Paulvin
Updated on September 10, 2021

You’ve worked hard to be where you’re at in your career. You’re finally getting paid for your intellectual capital and brain performance under pressure. Yet, sometimes brain fog, forgetfulness, and fatigue start to set in, so you’re looking for nootropics (brain-enhancing supplements and drugs) and other means to help you stay at the top of your game.

With our 360^o approach, we’ve had great success combining nootropics with addressing individual root causes of brain fog for hundreds of executives like you. Nootropics can help but they will not replace the basics that your body needs for optimal brain function. So, in this article, we’ll first cover the root causes of brain fog and then look at the common nootropics for brain fog.

What causes brain fog?

An intense lifestyle of always being on the run, working around the clock, eating out, and constantly traveling can wear down on your body and, thus, your brain.

The following are the potential root causes that we test for and address among our executive clients who struggle with brain fog, focus, and daytime fatigue.

1) Neuroinflammation

Brain fog, fatigue, lack of motivation, and mental health issues can be symptoms of neuroinflammation. The inflammation could come from any of the following:

Unhealthy diets and food-related inflammation
Autoimmunity and allergies
Lack of restorative sleep
Infections
An imbalance of the gut bacteria (dysbiosis)
Deficiencies of nutrients required for balanced immune function, such as vitamin D
Concussions or mild traumatic brain injuries, even ones from decades ago

Aside from neurons, there are also immune cells, such as astrocytes and glial cells, in your brain. They protect your brain from germs and also help clean up the damage, misfolded proteins, and cellular wastes. Inflammation from lifestyle sources can activate these immune cells and prime them to react with more inflammation.

Glutamate is a very important and most abundant excitatory neurotransmitter in your brain, but you want to have just the right amount. Too much glutamate jams nerve cell communications, killing them and causing brain fog. Neuroinflammation increases glutamate levels in your brain and reduces brain-derived neurotrophic factor. At the same time, it increases toxic neurotransmitter metabolites that are linked to depression.¹

If you’re struggling with brain fog, it is important to investigate possible sources of neuroinflammation and address them accordingly.

Some of the treatments that I use to help my patients with neuroinflammation include:

Spermidine – enhances the cellular renewal process where your cells and neurons literally eat their old components to reuse the building blocks.² Spermidine supplementation improves cognitive function and protects against age-related memory impairment.³
Low-dose naltrexone – naltrexone is an opioid antagonist. Low doses (1 – 5 mg/day) can reduce neuroinflammation caused by glial cells.⁴

2) Oxidative stress, mitochondrial dysfunction, and aging

Your brain cells are heavily dependent on the mitochondria (tiny energy factories within the cells) for energy. Oxidative stress can inhibit mitochondrial function, creating more oxidative stress and inflammation. These can damage your cells and the mitochondria inside them, causing cellular aging and reducing your ability to produce energy (ATP). As a result, you’ll feel tired and brain fog. You may even start to experience weight gain and other conditions of aging.

There are a few potential contributors to high oxidative stress in the brain.

A diet that’s low in antioxidants. These are found in fruit and vegetables.
A fast-paced lifestyle. This will expose you to excessive oxidative stress.
Chemical exposure
Air travel
Emotional stress

Fortunately, you can increase your antioxidant capacity and resilience to these factors by eating more antioxidant-rich foods and using the right supplements and biohacks.

Oxygen is important for mitochondrial function. Lack of oxygen can contribute to mitochondrial dysfunction and increase oxidative stress, leading to brain fog. While some nootropics can increase blood flow to the brain, it is important to address factors that can affect brain blood flow and oxygen delivery. These factors may include anemia, sleep apnea, poor posture, poor circulation, and too low or too high blood pressure.

Oxidative stress can cause biological aging, which is a common contributor to cognitive decline, along with chronic inflammation that affects the whole body.⁵

Treatments I often use for cellular aging and mitochondrial dysfunction include:

Nicotinamide adenine dinucleotide (NAD+), which is an important metabolic cofactor. Low NAD+ is a marker of mitochondrial dysfunction, cellular aging, and neurodegenerative diseases.⁶ NAD+ therapy can stimulate the healing processes in your body, even though many people need to start slowly. Ways to increase NAD+ include NAD+ patches, IV therapy, and supplements that increase NAD+, such as nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN).
Alpha lipoic acid is a powerful mitochondrial antioxidant. It helps recycle other antioxidants, such as coenzyme Q10, vitamins C and E, and glutathione. In animal studies, it protects neurons and helps with mitochondrial dysfunction.⁷
Urolithin A is a gut bacteria metabolite of a polyphenol found in nuts and fruits. It protects neurons from oxidative stress and increases building block recycling (autophagy) through the SIRT1/mTOR pathway.^8,9
MOTS-C is a mitochondria-derived peptide that can improve memory and inhibit cognitive impairment from neuroinflammation.¹⁰ It also inhibits astrocytes and microglia, and the production of inflammatory cytokines.¹¹
Low-level laser therapy, especially with near-infrared wavelengths that can travel through the skull and reach the brain, shows promise with treating brain fog and traumatic brain injuries.^12,13

3) Toxic exposure

Many environmental toxins and chemicals that we are exposed to every day are neurotoxins.¹⁴ Recently, I have seen a significant rise in mold-related symptoms among patients in New York City. If you start developing brain fog or other symptoms after being in a new location, such as a new office building, home, or gym, it is important to investigate mold illness or other environmental toxic exposures. There are urine tests that can screen for these toxins.

Mold in particular can trigger chronic inflammation and create oxidative stress, interfere with your sleep, throw off your hormones, and make your nervous system more sensitive. Many people who suffer from mold illness are very sensitive to any and all interventions. This necessitates professional medical supervision. This article, Mold 101, outlines our approach related to mold.

Other types of toxic exposure can also contribute to brain fog because they add to your toxic burden. Nowadays, an average woman is exposed to over 500 chemicals before she leaves the house. These chemicals come from personal care products, perfumes, house cleaning products, and pollution. Pesticides and heavy metals are also neurotoxins that can be found in foods. Each of them may not cause any symptoms at their legal limits, but all of them combined can contribute to brain fog and cognitive decline.

4) Stress, traumas, and an unhealthy mindset

Chronic activation of the stress response system can result in hypothalamus-pituitary-adrenal axis dysfunction (often called “adrenal fatigue”). In the short term, stress suppresses your immune system and reduces inflammation. A prolonged stress response increases inflammation and oxidative stress, which inhibits mitochondrial function.¹⁵All of these can contribute to stress-related health problems, memory loss, and brain fog.¹⁶

Traumatic experiences and unhealthy mindsets can also keep your stress response hyper-activated. Post-traumatic stress disorder and childhood traumas have long been linked to cognitive dysfunction.^17,18 This explains why brain fog also tends to be a symptom of depression and anxiety.

Clinical studies have unequivocally shown that mindset affects overall health and brain function. In middle-aged adults, repetitive negative thinking increases Alzheimer’s pathology and accelerates cognitive decline.¹⁹ Many people who have experienced some degree of trauma fall into negative mindset patterns which increase their unhealthy stress responses.

These baseline ongoing stress responses from trauma and unhealthy mindsets take away from your stress resilience and keep you from performing optimally, which is why it is essential to address these.

Being an executive inevitably involves a stressful lifestyle. However, it’s your body’s stress perception and ability to recover from the stress that determines whether the stress is unhealthy. In our Executive Optimization program, we use an individualized suite of tools to improve your stress resilience so that you can perform your best under pressure.

5) Poor blood sugar regulation

Your brain is your most energy-consuming organ. It contributes to only about 2% of your body weight yet consumes up to 20% of your glucose intake at any given time. Therefore, unhealthy fluctuations in blood glucose and insulin resistance can adversely affect your brain health. It makes sense then that brain fog, fatigue, and other types of cognitive dysfunction are known symptoms of diabetes.²⁰ Also, this is why Alzheimer’s has been dubbed type 3 diabetes.²¹

You don’t have to be diabetic for your brain to be affected by poor blood sugar control. You can experience the effects just by eating a single meal that creates a blood sugar rollercoaster. Also, glucose is an oxidizing sugar. High blood sugar can increase oxidative stress that suppresses the activity of orexins. Orexins are nerve cells that multi-task to regulate a set of vital bodily functions such as sleep/wakefulness, appetite, energy levels, and cognition.²² Suppressing orexins can make you tired and brain fogged. On the other hand, low blood sugar can also leave you feeling cranky, tired, brain fogged, and hungry.²³

One of the best things you can do for your brain is to eat a diet that keeps your blood sugar steady. I usually have my patients use continuous glucose monitoring to see how each food, activity, or stressor affects their blood sugar.²⁴ Many of them are surprised with their blood sugar response to certain foods or stressors.

Some supplements like berberine can increase insulin sensitivity, stabilize blood sugar, and reduce carbohydrate cravings.

Many executives also find they get an additional boost in brain energy by adding exogenous ketones or going on a ketogenic diet because ketones are excellent fuels for brain cells. As a side benefit, some also experience fat loss and a reduced risk for all kinds of chronic diseases.

6) Insufficient and poor sleep

During sleep, your brain processes new information and stores memories, while also cleaning up toxic wastes. Your body also undergoes a hormone, detoxification, and circadian reset. Lack of sleep is not only stressful for the body but also increases oxidative stress and inflammation, which impair your brain function.^25,26

As a busy executive, sleep is a worthwhile investment of your time, but you want to get the most out of your time investment. Sleeping well involves more than just lying still for eight hours every night. For your brain to function optimally during the day, you need to enough achieve deep and rapid eye movement sleep, and sleep through the night without disruption.

To optimize sleep quality, we start with sleep quality data obtained from wearables such as the Oura ring or BioStrap. Then, you can work on improving your sleep hygiene and adding interventions that can maximize your sleep quality. For example, L-theanine promotes relaxation by increasing GABA and serotonin, so it reduces the time you need to fall asleep and improves sleep quality.²⁷

While many supplements and interventions can improve your sleep or counteract the short-term effects of poor sleep, there are no nootropics that can replace good sleep. Therefore, optimizing sleep is an essential component of overcoming any kinds of cognitive issues.

7) Infections and dysbiosis

Infections can increase inflammation and oxidative stress, so chronic ongoing stealth infections, both in the gut and systemic, can contribute to brain fog.

Your gut bacteria affect all aspects of your health. Studies show that gut health, gut bacteria, and your brain work together in a gut-brain-microbiome axis. For example, your gut bacteria produce and metabolize your neurotransmitters. We also know that stress can change your gut bacteria. Having an imbalance in your gut bacteria can contribute to cognitive dysfunction.²⁸

Infections such as yeast overgrowth and Lyme disease can also result in neuroinflammation that causes brain fog. It is important to screen for these infections and address any that are found, both with antimicrobials and by supporting your immune system.

8) Hormonal decline and imbalances

Every one of your brain cells has receptors for sex hormones and cortisol. Therefore, imbalances in sex and stress hormones inevitably affect brain function.

Testosterone is one of the most important hormones for cognitive function. It increases the nerve growth factor in the brain.⁴⁶ It also protects neurons from oxidative stress, glutamate toxicity, and Alzheimer’s pathology, especially in the hippocampus (your brain’s memory center). ^47,48

Many of my male patients’ low testosterone levels manifest as declining cognitive function and low mood. In both men and women, testosterone levels seem to have a U-shaped relationship with many aspects of cognitive function, including memory, concentration, attention, and mental control. Testosterone replacement therapy helps improve memory and many other aspects of cognitive function in men with mild cognitive impairment (pre-Alzheimer’s disease).^49,50

For women, menopause, with its associated estrogen decline, is one of the biggest contributors to Alzheimer’s disease. This explains why Alzheimer’s affects more women than men. Testosterone replacement therapy also improves verbal learning and memory in menopausal women who are not taking estrogen replacement therapy.⁵¹

Dehydroepiandrosterone sulfate (DHEA-S) is an important steroid precursor to estrogen and testosterone. Supporting DHEA-S levels with supplements may reduce age-related cognitive decline, especially in older adults.²⁹

In my practice, I use an advanced hormone test called the DUTCH test, which shows hormone and hormone precursor levels. It also shows your active hormone levels and how your body metabolizes these. I advise my executive optimization patients on options to optimize their hormones, including improved diet and lifestyle, peptides, biohacks, and hormone replacement.

9) Lack of hormeses (exercise, heat, sunlight exposure, etc.)

Hormeses are small doses of stressors that make you stronger. Most of them work by stressing your mitochondria just enough that you get a healthy boost in mitochondrial function and cellular antioxidants. They also influence your brain by balancing your neurotransmitters and increasing your BDNF levels.

An overall lack of hormeses can have an aging effect, resulting in unhealthy mitochondria whereas having healthy doses of these improve your body’s natural ability to counteract oxidative stress, thus having a net anti-aging effect.

As a busy executive, there are many ways you can harness the power of hormeses without investing a lot of time. This can range from red light therapy and infrared sauna to high-intensity exercise, cold exposure, and intermittent fasting.

How do you measure brain fog and whether the interventions are working?

You manage what you measure. To fix brain fog, mental fatigue, and other types of cognitive dysfunction, it is important to get a baseline test done and thereafter regularly test to see if you’re making progress. Often, interventions and nootropics improve these scores before you start to feel the difference, so it’s important to measure so that you know you’re making progress. There are many tools that can non-invasively assess brain function, such as Quantitative Electroencephalogram (qEEG), Brain Gauge, and Brain Tap.

Quantitative Electroencephalogram (qEEG)

qEEG, or brain mapping, measures electrical activities in the form of brain wave patterns. Your neurons transmit impulses with electrical signals, which can be detected via qEEG probes.

To get an EEG readout, you’ll wear a hat or headpiece with electrodes that correspond to regions of the brain, with conductive gel between the electrode and your scalp. Then, the EEG device will detect the electrical activities, and a computer program detects it.

Specific changes in brain wave patterns correlate with cognitive dysfunction, such as the reduction in alpha brain wave and power spectral ratios. Different neurological diseases, such as Alzheimer’s, frontotemporal dementia, ADHD, and bipolar disorder have their specific patterns on qEEG.⁵²Also, some of these patterns may be detected years before you get diagnosed with neurologic disease, making qEEG a powerful preventive tool.⁵³

Brain Gauge

We use the Brain Gauge in our office because it provides a quantifiable score that indicates your reaction time, focus, fatigue, timing perception, reaction time variability, and accuracy. Particularly, reaction time variability correlates with ADHD and poor impulse control.³⁰

Measuring brain fog with Brain Gauge involves playing a 15-minute computer game that measures your ability to tell apart two tactile stimuli on your index and middle fingers.

Studies have shown that your ability to distinguish two very similar and nearby stimuli maps relates to the somatosensory cortex region of your brain. Neuroinflammation, which increases glutamate, impairs this ability.³¹ Because the Brain Gauge is engineered to have millisecond accuracy, it can provide quantified data in numbers of milliseconds.

Therefore, the Brain Gauge can indirectly quantify your neuroinflammation and thus measure brain fog.

Nootropics and peptides for brain fog

Nootropics are foods, supplements, and medications that improve brain performance.³² Many of them also work as adaptogens by improving your ability to perform during stress. There are many different ways nootropics work, including³³:

Increasing acetylcholine levels, which improves memory. Clinical trials have also found that many natural substances that increase acetylcholine may help with Alzheimer’s disease.^34,35
Improving the balance between GABA and glutamate functions, which is important for overall nervous system function
Supporting healthy glutamate signaling in the brain through AMPA and NMDA receptors
Increasing proteins that stimulate neuronal growth and adaptations, such as brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF)
Counteracting inflammation and oxidative stress in the brain
Boosting mitochondrial function
Providing fuel for neurons

Natural nootropic supplements for brain fog

These natural brain-enhancing supplements are generally well-tolerated in moderate doses. They also have no addictive potential. Many nootropic supplement companies stack these ingredients together based on their complementary biochemistry. Some even mix them with coffee, since caffeine is also a nootropic.

Some of the most popular natural nootropics include the following:

Bacopa monnieri is used in Ayurvedic medicine and has a long history of use for its memory-enhancing effects. It works mainly by increasing acetylcholine and other neurotransmitters. Therefore, it improves attention, learning, cognitive processing, and working memory.³⁶

Lion’s mane or Hericium Erinaceus is a fuzzy-looking medicinal mushroom used in traditional Chinese medicine. This medicinal mushroom has been tested and shown to improve recognition memory in experimental trials. It is a potent stimulator of BDNF and NGF.³⁷

Alpha GPC is a choline-containing phospholipid, which can cross the blood-brain barrier and provide a backbone for acetylcholine.

Medium-chain triglycerides (MCT) oil and exogenous ketones – Medium-chain triglycerides are quickly converted into ketone bodies which can readily enter the brain to fuel neurons. One limitation of MCT oil is that taking too much of it can cause digestive upsets and loose stools. Exogenous ketones can get you into ketosis faster than MCT oil as it doesn’t require digestion. However, some people experience nausea, digestive upsets, and diarrhea when using exogenous ketones.

Being in ketosis also works as a hormesis that strengthens your mitochondria, which is good for your brain function and longevity.³⁸

Most of the natural nootropics can be taken at any time of the day as they don’t tend to be stimulating, with the exception of herbs in the ginseng family. If you notice your sleep quality deteriorating when you take them too late in the day, then the nootropics could be interfering with your sleep. Also, taking herbs and substances that increase acetylcholine levels may cause lucid dreaming.

Smart drugs for brain fog

Racetams refer to a group of over 20 compounds with similar backbones which help improve focus. Scientists still don’t fully understand how they work but they seem to increase acetylcholine receptors, boost neuronal metabolism, improve GABA function, and counteract cellular oxidative stress.³⁹ They also boost blood flow to the brain. In the US, racetams are borderline unapproved drugs due to the lack of clinical data.

Modafinil is a stimulant medication used to treat daytime sleepiness in narcolepsy, sleep apnea, jet lag, and shift work sleep disorder.⁴⁰ Modafinil helps an unrested brain perform as if it is well-rested by improving driving simulator performance and reaction time. It increases glutamate, serotonin, histamine, and orexin levels outside of neurons in the brain, while reducing GABA.⁴¹ Reported long-term side effects of Modafinil in a clinical setting were headache, nervousness, and nausea.⁴²

Adderall is an amphetamine medication indicated for ADHD. In non-ADHD people, it has small cognitive-enhancing effects. Adderall improves an individual’s ability to focus and stay on task.^43,44 Keep in mind that it also has many possible side effects which can cause changes in the cardiovascular, gastrointestinal, endocrine, and central nervous systems.⁴⁵ It also has the potential to be addictive and may cause hallucinations.

The latter two are central nervous system stimulants, so you should take them early in the day and be careful when mixing them with caffeine. When in doubt, consult your healthcare provider.

Because your brain can become tolerant of or dependent on these nootropics, both natural and pharmaceutical, it is important to occasionally cycle off of them. Some people find it most convenient to stop using them on the weekends.

How do I select the best nootropics for brain fog?

There are many factors we take into account when recommending the best personalized treatments and nootropic stacks for brain fog, including:

The root causes of your cognitive dysfunction. For example, neuroinflammation requires a different intervention to nutrient deficiencies.
Your overall brain and mental health picture. For example, forgetfulness relates to acetylcholine, whereas lack of focus may relate to dopamine. If depression and anxiety are present, then we may need to look at supporting serotonin.

We’ve found our individualized and thorough approach to work best long-term because we work with your body to address the root causes that led to the brain fog. It also maximizes your health and longevity in your career. Whereas, blindly using nootropics tends to work only to suppress symptoms without addressing the underlying malfunctions.

To learn more about our approach, click the button below.

Learn more about our Executive Optimization Program